Tuesday, February 20, 2007

The progressive destruction of medical education

By Dr Amanda Neill -- a former lecturer in anatomy and related disciplines

Medical education is in serious trouble, and has been for a number of years. Recently there have been several articles questioning the level of the most basic knowledge of the medical graduates, much of it coming from the new graduates and students themselves. Surveys - some of them initiated by medical students - have revealed that they do not feel they know enough anatomy, physiology and pathology; that they are not taught, but rather thrown into a "sea" to learn in a "self-directed" fashion, and that they do not feel prepared enough to go out to practise medicine. Never has a profession's education been so mutilated, mucked-about-with, or mucked-up.

It is obvious to anyone that to fix a human body one should at least know about its components (anatomy), how these components interact (physiology), and what can potentially go wrong with them (pathology). All the rest is smoke and mirrors.

Yet the smoke and mirrors is all that the medical schools are teaching. Students these days can have remarkably good understanding of technologies such as magnetic resonance imaging, while remaining startlingly ignorant of the bones, fascia and other structures of the hand. No GP surgery will have an MRI scanner, yet every GP will routinely see patients with sore or injured hands.

One of the major reasons for the shift in what is being taught is that medical education is not being taught by doctors. Doctors are not teaching student doctors; rather science and other graduates with or without PhDs have gazumped university staff teaching appointments. It is very difficult to find a medical graduate on any university staff, and even rarer to find them in the medical schools. This is no accident.

In the 80s and certainly the 90s, medical schools started to rid themselves in a determined fashion of medical graduates on their staff and employ science graduates with strong research backgrounds to teach medical students - when they had the time. These researchers on the whole did not have any vocational training, had never been on a ward or treated a patient, and did not have a strong interest in teaching. Certainly they did not have, and were not required to have, teaching as their main priority, and still do not. Teaching of vocational degrees such as medicine, dentistry, pharmacy and veterinary science should never have been given to those in a research-focused environment such as the modern university. Neither teaching nor research is then done well.

When medicine and then other vocational courses first became taken over by this shift in thinking, initially medicine was taught by medical graduates, who knew what was needed, had been on the wards, and had a thorough knowledge of the human body. Gradually the art of teaching medical subjects and the need to teach them became lost as the ever-increasing number of PhDs grew and vied for positions on the university staff. After all as John Collins, dean of education for the Royal Australasian College of Surgeons, wrote in Weekend Health (December 16-17, 2006), there has been an explosion of medical knowledge and technology.

Whatever explosion there may be, a leg is still a leg and a stomach still a stomach. Despite Darwin's theory of evolution, these are remarkably constant, and the structures are unchanging. To fix them (the leg and the stomach and all the other structures in the body), to understand them, the doctor needs to know where they are, what is above, below, in front and behind, and what common variations of these arrangements may exist. This knowledge should not just be the province of the surgeon and the radiologist.

We live in dangerous times. Universities are currently agitating to take over, or have already taken over, the teaching of other vocational courses such as for ambulance officers, paramedics, police, physiotherapists, chiropractors, occupational therapists and nurses - and in each case the pattern is the same. Less and less of the training is done by those who have been working in the relevant profession, and more and more PhD graduates with a research focus take on the teaching and designing of courses, with a view to teaching on the side and/or to protecting their area of expertise, no matter how irrelevant. They also have minimal teaching experience. Students learn more and more about less and less relevant material. They are less ready to take on their role as a doctor, or the work necessary to do this job.

Currently in many courses textbooks are no longer prescribed, but a recommended reading list and stacks of photocopied papers and hastily prepared lecture notes are given to the students. They are told to go and get on with it - and this is in the more structured courses. Others are completely self-directed and there is no actual teaching at all. This is lazy and cannot readily be evaluated. It is subject to change on a whim and leaves the student floundering in a sea of few definites. Facts, half facts, and fashionable views are weighted the same and it is difficult to gain an ability to determine what is true and what is "true for the moment".

Most doctors want to be doctors, and although many have open and enquiring minds and may want to go further into research and other developments, this is not what medicine is all about. It is about medicine, not the latest whiz-bang gadget, or the latest theoretical approach. By all means if this is the direction the student/doctor wants to take after graduation, so be it. But a lot of current research is too narrow, precisely because many researchers lack a basic comprehensive knowledge of the body's structures. For example, pathology of the liver can affect the eye, but research about the eye will be flawed if those conducting it lack this basic understanding of other organs and what relevance this may have.


A teacher must not have girls sit on his lap

Another step towards making male teachers an endangered species

Prosecutors filed eight new child molestation counts on Wednesday against a substitute elementary schoolteacher suspected of inappropriately touching his young students. Each of the new counts against Eric Norman Olsen represents a new victim, meaning Olsen now stands formally charged with molesting nine girls. He faces up to 28 years in state prison if convicted as charged. Olsen pleaded not guilty to the new counts during a brief hearing Wednesday morning in West Valley Superior Court.

His attorney, Gina Kershaw, said afterward the allegations against Olsen have been blown out of proportion. "He's really a good guy who has been thrown into an unfortunate situation," the attorney said. Kershaw said no students have reported Olsen touched their private parts.

The only evidence suggesting his contact with them was at all sexual is a letter he wrote at the urging of police in which he admitted to gaining sexual arousal from having young girls sit on his lap. Kershaw said she believes Ontario police used coercive tactics to trick Olsen into writing a false confession. "They're good at what they do, they interrogate, that's what they did in this case," the defense attorney said.

Olsen was arrested Aug. 3 on suspicion of molesting a 10-year-old girl at the Berlyn School in Ontario. In that case, authorities said Olsen had the girl sit on his lap and rubbed her back underneath her shirt. He was charged with three counts of child molestation stemming from that case and he remained in jail while police sought other possible victims. Deputy District Attorney Jason Anderson said six of the new victims were students in the Central School District in Rancho Cucamonga. Olsen is accused of molesting all six on the same day, Dec. 20, 2005. One new victim is from the Fontana Unified School District. Authorities believe Olsen molested her sometime in the 2005-06 school year, according to a criminal complaint. The remaining victim is from the Ontario-Montclair School District. Prosecutors allege Olsen molested her sometime in March.

All eight girls were about 5 to 7 years old at the time of the alleged incidents. All the allegations involve Olsen placing the girls on his lap, the prosecutor said. "There are witnesses to it," Anderson said. "The young ladies are clear about who the teacher was and what the conduct was." Police have said at least 12 possible victims have been identified since Olsen's arrest, including the eight represented by the new charges on Wednesday.

Source. (To avoid the risk of a trial, the teacher eventually pleaded "No contest". Sentence has not yet been handed down)


For greatest efficiency, lowest cost and maximum choice, ALL schools should be privately owned and run -- with government-paid vouchers for the poor and minimal regulation.

The NEA and similar unions worldwide believe that children should be thoroughly indoctrinated with Green/Left, feminist/homosexual ideology but the "3 R's" are something that kids should just be allowed to "discover"

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